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Provider Outreach Specialist

Job Snapshot

Job ID: 52619

Location: Latham, NY

Posted: 9/11/2017

Category: Health Care

Experience: At least 2 year(s)

Education: See Requirements

Job Description

About the Position:

We are currently seeking dynamic Provider Outreach Specialists to join our growing team in Latham, NY! The Provider Outreach Specialist will be responsible for negotiating Single Case Agreements (SCAs) for out of network providers and completing tasks related to this function.

The Provider Outreach Specialist must provide complete and accurate information on all inquiries and meet deadlines per established departmental policies. This individual works in several systems simultaneously, handling work queues in the provider, clinical and customer service applications. This individual must meet or exceed established productivity and quality standards. The Provider Outreach Specialist communicates with internal departments and providers via event, inquiry, and in written correspondence.

Conduct follow up protocols on SCA requests to conduct the proper provider/member checks, gather the appropriate provider documentation, negotiation rates if applicable, coordinate with the clinical team to authorize the treatment, execute the SCA and assist with provider data entry and rate loading.

Oversee the administration and tracking of all assigned SCAs and coordinate with other teams as needed to facilitate completion of requests.

Perform complete investigation and conduct the necessary follow through on all inquiries regarding SCA requests. This includes inquiries related to initial requests, exception requests and follow up requests.

Research and accurately respond to inquiries regarding the status of SCAs.

Monitor work queue to ensure cases are processed within expected turnaround times.

Job Requirements

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